Speaker 1: You are listening to Love Maine Radio hosted by Dr. Lisa Belisle and recorded at the studio of Maine Magazine in Portland. Dr. Lisa Belisle is a physician and editor-in-chief of Maine, Maine Home+Design, Old Port, Ageless and Moxie magazines. Love Maine Radio show summaries are available at lovemaineradio.com.
Lisa Belisle: This is Dr. Lisa Belisle and you’re listening to Love Maine Radio show number 348 airing for the first time on May 20th 2018. Today, we speak with Emily Sharood of Mousam Valley Mushrooms and woodworker Johnny Dickinson. We also speak with Dr. Dan Landry who has his own clinical practice and is an advocate for health care reform within Maine and throughout the United States. Thank you for joining us.
Speaker 1: GrownUpgirl.com where you can get personalized guidance and encouragement for growing a simple yet vibrant life through free advice, workshops, and mentoring programs with local experts. You deserve to shine. Go to grownUPgirl.com now to learn about our available programs and classes designed just for you in the Portland area. Portland Art Gallery is proud to sponsor Love Maine Radio. Portland Art Gallery is the city’s largest and is located in the heart of the Old Port 154 Middle Street. The gallery focuses on exhibiting the works of contemporary Maine artists and hosts a series of men through solo shows in its newly expanded space including Brenda Cirioni, Daniel Corey, Jill Hoy, and Dave Allen. For complete show details, please visit our website at artcollectormaine.com.
Lisa Belisle: Emily Sharood is the sales and marketing director at Mousam Valley Mushrooms. And Johnny Dickinson is a woodworker and owner of Winter Hill Design. Thanks for coming in today.
Johnny D.: Thanks for having us.
Emily Sharood: Thank you.
Lisa Belisle: And you brought with you these really beautiful organic Italian oyster mushrooms. They’re in this wonderful cardboard box and they’re so pretty, I want to take them out and start cooking with them or at least just admiring them. You guys had a lot of time to admire the mushrooms.
Emily Sharood: Absolutely. Our Italian oysters have a almost like a chicken teriyaki flavor to them. I’ll cook them whenever we’re doing shows or we’re introducing them to a new chef or an institution. And people will think that I’ve done some sort of spectacular cooking thing with them, but really it’s just simple salt pepper and sauté in a pan for about 15 to 20 minutes. And really it’s just the flavor of the mushroom coming out that kind of has that umami sort of flavor to.
Lisa Belisle: That’s very interesting that mushrooms don’t all taste like mushrooms, they taste like different whatever they are whether it’s Italian oyster or whether it’s a hen of the woods or whether it’s shiitake. Is this specific to the type of mushroom? Is it specific to where they’re raised? Why do they all have different flavors?
Emily Sharood: Mushrooms are a really neat protein in the sense that they are able to absorb whatever sort of flavors and oils that you cook them in. Their tissue structure is similar like a sponge, it’ll just soak up all those flavors in the pan. But then they also do have their own individual tastes as well. And that really does come from the substrate that they’re grown in. It’s important to us at Mousam Valley Mushrooms to ensure that we’re growing them on hardwoods as well as using cottonseed holes and other agricultural byproducts so they taste as natural and organic as possible. And it really shows and reflects in not only the way they look, but in the way they taste as well.
Lisa Belisle: Why mushrooms of all things?
Emily Sharood: Well, I’d have to start back to the beginning about seven years ago at this point in my brother Robert’s backyard in Sanford, Maine. We were starting a permaculture garden, he was suffering from stomach issues at the time and doctors weren’t really sure as to what it was exactly. Rather than going the pharmaceutical route, he decided to begin growing his own food, primarily meats like poultry and rabbits as well as vegetables and fruits. And at the basis of this permaculture garden was the mushroom, the mycelium root. It helped turn that sandy Sanford soil into this rich loam that allowed us to create such a garden. Not only was it supplying us with good soil to grow the other varieties of foods, but it also allowed us to feed the poultry and the ducks with the insects that were attracted to the substrate.
And then also in turn, we were able to eat and have these amazing mushrooms on our dish. I was going to school for marketing and design at the time and then Robert was going to school for business management. And we were both seniors and looking to create our senior thesis and came up with the idea to collaborate. And I started doing the marketing and the graphic work and designing a website and a mock logo. And we came up with the name Farming Fungi LLC. And then it transitioned into the brand Mousam Valley Mushrooms once we ended up locating this barn, a dairy barn that hadn’t been used in about 50 years right in Springvale, Maine.
As it started to develop, we approached my father John on his 50th birthday along with his L.L.Bean slippers, he also got a business plan to farming fungi. And he started doing market research, his background is in entrepreneurialship and working with startup software companies. He started doing some market research and really saw that there was this niche market in the New England area where there was no specialty local mushrooms. It was really just the agaricus strains like the white button and the Portobello mushroom, which is mostly based out of Pennsylvania. We approached Whole Foods and Hannaford to find out if they would be interested in purchasing a product and selling this to their consumer. And they were on board with it.
We started looking into applications, grant applications through USDA for marketing as well as an MTIC grant to create the grow rooms. And then once we found the barn again in Springvale, Maine, we started creating the grow rooms using a proprietary software system that my father John helped design with Mackenzie Designs Engineering. And from there, we started growing a few pounds of mushrooms all the way up to about 3,000 pounds of mushrooms a week at this point. And that’s within a five to six-year span.
Lisa Belisle: Johnny what is your relationship to-
Johnny D.: She’s my fiancée.
Lisa Belisle: Okay. Well, I was going to ask about to the mushrooms, but okay. Your relationship to Emily she’s your fiancee. But you have a bachelor in fine arts from the Maine College of Art in woodworking and furniture design and you build the structures that hold the mushroom blocks for your mushrooms.
Johnny D.: Ever since the mushroom farm started, I’ve always just been there to help out with whatever I can. That usually entails building and creating shelving units and basically anything made out of wood. I’ve always been there to help out and harvest the mushrooms and gone to lots of food shows with them. I’ve kind of had a, I don’t know, a side employment kind of. I don’t know what to call it, but just being there on the sidelines helping out because she’s my lady.
Emily Sharood: We started out way back in the day foraging for mushrooms. We used to go for trail walks. And at that point in time, Johnny wasn’t so familiar with actually eating mushrooms that have been growing in the woods and one thought I was a little bit crazy when we were … I remember this one time specifically, we were grilling chicken of the woods that we had just foraged off of one of our local paths. And I was so excited that we had found it together and I had cooked it up over the fire. And I was like, “Oh, here, try this.” And Johnny he was like no. And at that moment, I was like, “Wow, I’m not sure if this is going to work.” And with that, he took his first bite of chicken of the woods and we haven’t really looked back since.
Johnny D.: Yeah. That was a turning point for me. I like mushrooms now.
Lisa Belisle: That’s a good thing, it sounds like. It could have been a problem if that hadn’t happened.
Johnny D.: I think there was a little name-calling on it going to on a bit if I didn’t try the mushroom, I might have been a loser. And that wasn’t an option.
Lisa Belisle: No, nobody likes that. Why did you not like mushrooms is it just that when you were growing up, you didn’t eat a lot of them or?
Johnny D.: Yeah. You know kids are picky with food and mushrooms just always seem slippery and slimy and unappetizing. I always stayed away from them, I always avoided any food that had mushrooms. I would pick them out, but at best I would just not eat something that had mushrooms in it. And it took eating a really good mushroom that was cooked the right way for me to appreciate it. And now I love mushrooms and I cook them all the time. I think with art or with food or with anything, if you experience it the right way or in a good way that looks really good and tastes really good, you’ll appreciate it.
Emily Sharood: Whenever anybody tells me that they don’t like mushrooms, I have to agree that I don’t particularly like button mushrooms or even Portobello because they’re grown in dirt whereas our mushrooms are grown on this wood substrate so it has this really amazing earthy woody texture to it and flavor that’s just really appetizing. And the other the other thing is that people say, oh, it’s too slimy or meaty. What I particularly choose to cook them is by tearing them up into smaller pieces and allowing them to crisp up in the dish. It’s really all about how you cook it. And I would recommend to the people out there who feel like it might be too slimy for them would be to have them cut in smaller pieces and to cook them longer in the pan until they get nice and crisp. And that’s a really great way to enjoy them.
Lisa Belisle: Well, it’s funny because as you’re talking, I’m thinking about the difference between a heirloom tomato freshly picked off the vine in July and a refrigerated tomato that has come from California on a truck in the middle of winter. And there’s a big difference between one or the other. They both have their function if you wanted tomato in the middle of the winter, that’s the kind you get. But it shouldn’t be that surprising to us that more industrially grown mushrooms are going to have a really different flavor and profile than the ones that you are growing.
Emily Sharood: Yeah. And we try to bring both of those aspects together. You’re able to purchase our mushrooms year-round because we do grow them all indoors. And you don’t have to worry about the bugs, but you get the same feeling and taste and texture as you would if you had just forged it right off of your favorite walking path. But we’ve ensured that it’s the right variety to eat and consume and it’s at the perfect time to be picked. It’ll last about five to seven days in your fridge and you’ll have it in time to enjoy.
Lisa Belisle: That fortune piece is interesting too because there are some mushrooms that are poisonous. It’s not actually as easy as, “Oh, there’s mushroom growing, I’m going to go pick it and eat it,” you actually have to know what you’re doing. You’ve taken that guesswork out of the equation for people.
Emily Sharood: Yes, 100%. And I’d say at this point in time since Johnny is a woodworker and he’s lived here in Maine his whole life that he’s probably a better forager than I am, but don’t telling anyone that.
Johnny D.: You just told the world.
Emily Sharood: At this point, yeah, I think he is.
Lisa Belisle: You didn’t like mushrooms but you were good at finding them, is that what I understand Johnny?
Johnny D.: Yeah. I can read the trees and that’s how I go through the forest as I study the way the environment is changing. And I can kind of see I guess through the forest in a way, a different view than most people have is where I can kind of start to predict which direction I need to go to start looking for these specific types of mushrooms that we might be looking for that time of year. Just going from birch tree to birch tree looking for chaga or knowing, oh, there’s some really big old oak trees over there, maybe we’re going to find hen of the woods or chicken of the woods and just kind of guiding myself through that way I think tends to find a lot of mushrooms.
Most of the mushrooms we forage grow on trees or in some kind of symbiotic relationship with trees or they’re a parasite of a tree. If you know the trees, you’re basically identifying the food sources for the mushrooms and finding them that way.
Emily Sharood: Yeah. And then for those who are interested in looking for their own mushrooms, I always highly recommend three primary sources for confirmation and starting out with tree mushrooms because tree mushrooms are a lot less likely to be poisonous than ground mushrooms. Looking for oysters would be my go-to, that’s how I first started out, oyster mushrooms.
Lisa Belisle: You’ve mentioned chaga, which I believe originally was in Siberia or other colder weather countries that they were using it for its health benefits. And we now know that in Maine, we have this amazing source of really immune boosting, I guess I’ll just call it food or fungus. Is that the way you would refer to it?
Emily Sharood: Chaga is commonly known as a mushroom, it is definitely a fungus. But the chaga itself that we ingest is a sclerotia mass. And it almost looks like burnt bark on a tree as if somebody’s lit the tree on fire. But it’s got more antioxidants than even the pomegranate. It’s also been tested to have anti tumor, anti-cancer properties as well. And you wouldn’t actually eat it because it would be way too woody, you would steep it in tea. Just don’t go past the boiling point or else you’ll kill off the beneficial microflora that’s in there, but steep it in tea and add a little honey, some maple or birch syrup with it, some cinnamon, nutmeg and it’s a really delicious medicinal drink.
Lisa Belisle: We’ve talked about the Italian oyster mushrooms, you also offer shiitake and butter oyster in a mix, in a forest medley. Are there different health benefits to each of those types of mushrooms?
Emily Sharood: Yeah, absolutely. The shiitake mushroom has anti-inflammatory properties to it. Again, they’re all protein based so they all have that slow-release energy, which is great to have throughout the day. I like to even add mushrooms, I’ll cook the mushrooms up first and then add them to a salad and add an egg on top of that and have that as my start of the day. And it’s just a really great way to have energy throughout. But you can also have them at night too as a side dish as well. They’re really versatile in that way.
Lisa Belisle: How about the different tastes of the oyster mushroom versus the shiitake versus the butter?
Emily Sharood: Yep, the shiitake mushroom has more of an umami flavor to it. It’s one of our most mushroomy tasting ones. If people are really looking for that potent flavor, I would highly suggest the shiitake. I even like to cook them up nice and crisp again and make a bacon shiitake. If you’re a vegetarian, just use the shiitake themselves with a little bit of olive oil or if you are a bacon lover, I highly recommend cooking up some bacon and then using the bacon fat to cook your shiitake mushrooms. And I doubt it’s going to make it to your plate before it gets off the pan. And then Johnny is an amazing chef, what do you think about the flavors?
Johnny D.: I love them all. The shiitake again great with any kind of meat. Their texture is a little meteor as well, they’re a little more robust. The oysters are great with anything, with chicken, with veggies, stir fries, fried rice. The other varieties you grow, the lion’s mane are great with seafood. They kind of almost have a crab meat texture to them poached in butter and just lightly sauteed and served with crab cakes or even mixed into crab cakes. What else did we make those?
Emily Sharood: Our scallop, Johnny made an amazing scallop risotto and we added some lion’s mane to that as well and it was delicious. And then going back to the medicinal point, we call the lion’s mane brain mushroom. Not only does it kind of look like a brain in a way when you cut it open, but it actually has great cognitive function and is also being used as a treatment for Alzheimer’s as well as just for anybody who’s looking to think a little bit clearer. I highly suggest lion’s mane as well.
Lisa Belisle: I was talking to a forger recently and he mentioned that there’s a man on the west coast who’s doing work with mushrooms and soil detoxification, that mushrooms are very good at kind of, I don’t know soaking up oil spills or taking things out of the environment that aren’t so good for us. That being the case then it seems to make sense that they would just be picking up the good nutrients from the environment that we could then ingest.
Emily Sharood: Yep. Going back to the very beginning soil remediation was the big factor for us starting with the mushroom as our product. It’s really important to Mousam Valley Mushrooms to know that we are creating a product that uses agricultural waste necessarily to create a product for us to enjoy and eat. And then also our waste then goes back to other farms and helps remediate their soil because the mushroom root really is great at sequestering water and retaining it and then also releasing it when it is hot enough. It’s really helpful in that sense.
Lisa Belisle: It seems like this is a pretty humble thing that we’re talking about, this fungus that grows on trees and on the ground, forest floor. And yet it’s something that your family has decided to build this business around. And the two of you both are focusing so much attention on it. Is this something that you are surprised by? Would you have thought this would be the direction your lives would take?
Johnny D.: Not 10 years ago, no. I guess I didn’t really know you at the time, but finishing up high school and getting ready to go to Wentworth Institute of Technology to study industrial design, I pictured myself drawing and designing sports cars and everything like that. And then gradually got kind of tired of the artificiality of it all and realized how much I missed being back home in Maine and being in nature. And that’s when Emily and I kind of met and got together and just kind of both I think transitioned our lives back towards that.
Emily Sharood: Yeah, we’re both artists in a sense and we both love using mediums that are natural. It makes the most sense to us I think. My college career was in, I started out in pharmacy school. I always knew I wanted to help my community somehow and I’ve always been a helpful person, it’s kind of what brings joy and happiness to me. But I soon realized that the pharmacy route wasn’t for me and then went into fashion design, realized I loved design but that the fashion industry is not sustainable at the moment. I started diving deeper into what other interests I had and everybody needs food, it’s the foundation of life. That’s kind of what brought us to the mushroom because the mushroom is the foundation of life, it’s the beginning and it’s the end. It’s what keeps the circle going.
I just felt like I couldn’t go wrong with the mushroom. The earth needs it, we need it. It’s a stereotype that I want to help kind of break. There’s a symbiotic relationship between mushrooms and humans that I want to help bring about and make it mainstream because it’s beneficial for not only the earth, but it’s beneficial for us too.
Lisa Belisle: Tell me about Springvale, this is a part of Maine that not many people know about.
Emily Sharood: Roberts was living in Sanford at the time and Springvale is the town right over. And it’s got the Mousam River running through it. There’s this beautiful section of farms on Blanchard Road. And we knew starting out that we wanted to be around farms because we were going to be creating this substrate mushroom compost that needed to be moved to farms and we wanted to do it close by. Right off of this beautiful pond overlooking the valley, we found this picturesque dairy barn that had last been used as a dance hall and before that had been used as a dairy barn. And I’ve even run into a few people saying, “Oh, I used to milk the cows in there.” I’m like, “Well, yeah, now we’re harvesting mushrooms in there.”
It’s kind of nice to have that history behind it as well. And yeah, we’re also collaborating with the local farms around us. Our operations manager, Aaron Gonsalves has his own produce farm as well as a dairy farm, the whites dairy farm that he works with as well. And then we have Annette’s Gardens, they grow microgreens in greenhouses and then you have Rivard’s Blueberry Farm. It’s a beautiful area and location and the people and the food movement that’s going on in Springvale is so strong. We have a farm trail walk coming up in April. It’s really the community that brought us there, and we’re really excited to be a part of it.
Lisa Belisle: Johnny, what do you hope to do with your art moving forward?
Johnny D.: Well, I own my own business called Winter Hill Design. I do custom furniture and woodworking. I grew up woodworking with my dad so it’s always been a part of me. And like I said, when I went away to school for industrial design, I thought that was what I really wanted to do. But this woodworking and being in Maine has always been a part of me. I hope to just build my business organically, and I just can’t wait to have my own shop someday and just get to go out there and make whatever I want, hopefully things that people appreciate and want. I love creating things, I love working with wood, I love nature and mushrooms. And if we can incorporate mushrooms into furniture someday, that would be cool too.
Emily Sharood: That would be really neat collaboration, absolutely.
Johnny D.: I just picture us having a beautiful homestead with some land and just creating things all day, every day.
Lisa Belisle: Well, I look forward to digging into these Italian oyster mushrooms that you brought although it seems a little bit of a shame to ruin them because they’re so pretty. But I’ll look at them for a little while before I actually-
Emily Sharood: I know, they almost look like a bouquet of flowers really.
Lisa Belisle: They really do.
Emily Sharood: Johnny and I are getting married in September and I’m trying to figure out how I can incorporate the mushrooms in with the bouquets of flowers. We’ll make it work. Yellow Twist Floral Designs actually used our mushrooms for one of their weddings that they set up.
Lisa Belisle: Who knew these mushrooms had so many different sides to them. I’ve been speaking with Emily Sharood who is the sales and marketing director at Mousam Valley Mushrooms and also her fiancé Johnny Dickinson who is a woodworker and owner of Winter Hill Design. Thank you for coming in and talking with me today.
Johnny D.: Thank you so much for having us. It’s been a pleasure.
Emily Sharood: Thank you.
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Dr. Dan Landry trained and worked within the Harvard system in Boston as a pediatric anesthesiologist prior to joining Spectrum Health Care Partners in 1994. Over the next two decades, he managed the largest division within Spectrum and served as president and chairman of the board. This past January, he gave up his administrative positions within Spectrum to focus on his clinical practice and advocate for health care reform within Maine and throughout the United States. Thanks for coming in.
Dr. Dan Landry: My pleasure, thanks for having me.
Lisa Belisle: And you and I happen to be neighbors.
Dr. Dan Landry: We are, yes.
Lisa Belisle: We could just see each other out, you’re walking your dog with your wife Deborah on a regular basis.
Dr. Dan Landry: Yeah. In our little corner of heaven.
Lisa Belisle: Yeah, it’s a pretty amazing place Littlejohn Island. You grew up in Maine, you grew up in Sanford.
Dr. Dan Landry: I did, I grew up in Sanford, spent the first 18 years there. Went to high school in the public high school. After almost 20 years in Boston decided to come back.
Lisa Belisle: What caused you to leave Maine in the first place? I’m assuming it was educational.
Dr. Dan Landry: It was educational. I received a degree in mechanical engineering from University of Maine and then took a couple of years and was a ski bum in Vail. And then went to med school in Boston, and then trained in Boston. My wife was in school in Boston as well. But then after training and working for a few years, we came back.
Lisa Belisle: Did you meet Deborah also in Boston?
Dr. Dan Landry: No, we were acquaintances in college, only acquaintances. And then I met her on The T of all places while we were in Boston. I said, “I know you,” and history from there.
Lisa Belisle: Is she also from Maine?
Dr. Dan Landry: No. Well, she grew up in Pennsylvania but spent the last couple years of high school in New York and then went to University of Maine as well.
Lisa Belisle: For you, there’s something very personal about health care reform within our state.
Dr. Dan Landry: Yes. Having participated in health care for more than 30 years, are you referring to my injury or?
Lisa Belisle: Well, no, I was referring to just being from Maine. But now that you’ve done injury, I’m going to have to ask you about that.
Dr. Dan Landry: This is a word of caution for everybody that owns a ladder. Two and a half years ago, I fell off a ladder and broke both my legs and was a participant on the other side of health care, saw how it worked. I was lucky that I received excellent health care. But my injury, this didn’t propel me to go into health care economics but illustrates the problem. I was injured in the beginning of December, my health plan probably like everybody listening has a large deductible and I incurred roughly $15,000 of out-of-pocket expenses because it was on the end of one year and into the next. I am extraordinarily fortunate that I could pay for that, very few people in this country can pay for that. Less than half of the people in the US have $8,000 or more in the bank at any one time. Health care is the leading cause of bankruptcy in the United States. And of those 62% file for bankruptcy based on health care, 75% percent of those have health insurance.
I’m passionate about health policy because I believe that if we don’t reform the health care system in this country, it threatens everything we know. It threatens our infrastructure, our educational system, our social programs. And no matter which side of the aisle you find yourself on, it will threaten programs dear to you. We have to fix this health care issue.
Lisa Belisle: Are there a lot of people in your field, which is very sub specialized, pediatrics anesthesiology, are there are a lot of people in your field who are interested in health policy?
Dr. Dan Landry: I don’t believe there are many physicians that are interested in health policy per se on a regional, state or national level. That said, I think physicians are interested in health policy in the manner in which it affects their patients. A physician such as yourself who works on the front lines of medicine and deals with patients on an everyday basis, every patient that is undergoing treatment it has been shown that the finances of that care is forefront in their mind, much more so than whether or not they’re getting better. There was a study done on breast cancer, women with breast cancer whether it’s treatment, toxicity, treatment efficacy or treatment cost, the majority of women chose treatment cost as a determining factor of the type of treatment they would receive, which I think as a physician that’s not acceptable. That’s just not acceptable.
Lisa Belisle: Yeah, it’s actually rather scary because if you have somebody who’s deciding that she can’t actually go toward the type of treatment that she really needs, then it might not even be a cost effective way of dealing with it even in the short term.
Dr. Dan Landry: Exactly, exactly, exactly. It’s a pervasive problem.
Lisa Belisle: When you were growing up, did you know that you wanted to be a doctor?
Dr. Dan Landry: Well, interestingly enough, I have a big brother, David who’s seven years older than I am. I’m sorry David. He and his wife who is also a physician, she’s an internist. David went into medicine and I’ve kind of modeled myself after my older brother. I grew up without a father so David was a father figure. I modeled myself after him. He went into medical school, went in to be a physician and I followed in his tracks. And I was thinking of becoming a orthopedic surgeon because of my background in engineering. And both he and his wife said, “No, go into anesthesia.”
Lisa Belisle: Why anesthesia? What was his background?
Dr. Dan Landry: He was a biologist in college. They just said it was interesting, allowed flexibility, which it does. More flexibility than other specialties. And it was interesting, I’m glad I did it. They were right.
Lisa Belisle: What you’re talking about is something that has become an important consideration in medical school generally, which is lifestyle. And many of the people who are going through, being a doctor is hard enough. But as you’re going through if you’ve incurred a lot of debt and you also would like to have a family at some point, you do have to start looking around to decide, “Can I really even afford personally and financially to be a primary care doctor?”
Dr. Dan Landry: Right. It’s very difficult for folks. And I think the younger folks that are coming out of medical school have a better balance than I did. I’m not going to speak for you, but I remember I was just at the end of the year when the term resident physician versus visit was coming out of vogue meaning, a resident physician being one in training lived at the hospital. And the visit, which is the staff person came and went. And that was the norm, and that’s just not healthy.
Lisa Belisle: And I was a resident right before they changed the resident work hour rules, which meant that we were still even though we weren’t technically residents of the hospital, we were there a lot more than the current residents are.
Dr. Dan Landry: 120-hour a week was not uncommon, do you remember that?
Lisa Belisle: I do, I lived it.
Dr. Dan Landry: And now I think rightfully so folks coming out are saying, “I’m not going to do that.” And I think it’s better for them. But that raises the cost of care because it requires more physicians to deliver the same care. It’s a conundrum.
Lisa Belisle: When I was talking to a woman who finished residency just a little bit ahead of me as a surgeon and I had trained in family medicine, she mentioned that one of the problems with the resident work hour rules was that somebody still needs to be taking care of the patients. The work gets shifted back on to typically younger doctors but also sometimes older doctors who have already done their own version of 100-hour work weeks. The issue seems to be that we can move things around so that somebody else ends up dealing with whatever needs to get dealt with but, it’s still there.
Dr. Dan Landry: It’s still there
Lisa Belisle: There are still patients, they still need care. It’s still going to be expensive.
Dr. Dan Landry: The solution is, primarily hospitals which are now the largest employers of physicians, the solution is to hire more either physicians themselves or advanced practitioners. But the money is not there although physician cost of health care is only 11% of total expenditure. It’s not an overwhelming cost, but still hospitals operate on a very, very narrow profit margin. Most hospitals in Maine are losing money. The expenditure for additional physicians is just not going to happen.
Lisa Belisle: We’ve talked about some of the issues, what are some of the other issues that you’ve learned about during the time that you spent in administration and also in the study that you’re doing at the London School of Economics where you’re getting a degree in health policy and economics?
Dr. Dan Landry: It’s a broad question, what have I learned? I’ve learned that I firmly believe, I strongly believe that physicians should be in leadership positions in hospitals and health care. There is a growing trend that that is occurring, but physicians understand what it means to take care of patients and what is necessary, like this conversation you and I just had about the need for more physicians. We inherently understand that and administrators look at it more as dollars and cents. I think non-physician administrators certainly have their heart in the right place and are doing the right thing. This is not to malign them, I just think that physicians have a deeper understanding of what it means to take care of patients. They should be in charge.
And in Maine, there’s only one CEO of a hospital who’s a physician. And that’s Mark Fourre up at Waldo Pen Bay. And that’s a trend, that’s a movement in the right direction. Let’s see what else, you’d asked me what I’d learned. I think physicians should be more involved in leadership, but it’s hard for physicians because we don’t have the training. It’s taken me 15 years of on-the-job education of myself, primarily self education to learn about health policy and finance. It is very, very complicated who gets paid for what and why they get paid. My studies at London School of Economics have given me an insight into how other countries are tackling these problems. Most other countries around the world are coalescing around a capitated payment model, meaning I get paid X number of dollars to take care of you and that’s all the money there is. And the US has not moved in that direction.
Every country in the world is dealing with high pharmacy prices and high increasing health care costs, but some countries are doing it much better than us. These studies have given me a more global view, which has been helpful.
Lisa Belisle: How do we encourage more physicians to take positions of leadership within the health care system?
Dr. Dan Landry: That’s very difficult. I’ve been wrestling with that for a long time. Well, first of all, most of the times when physicians work in leadership positions as you’re moving up and gaining experience, they’re almost always unpaid positions. They’re just tacked on to the end of the day. An emotionally drained physician who then has to sit through three hours of meetings every is very difficult. Companies need to invest in young leadership, there’s no question about that. It’s really an investment that needs to be made. And we need to find leaders and invest in them but also train them as well. Send them to school, send them to programs to learn how to manage. And unfortunately, in my experience, I don’t have experience managing other folks other than physicians, but physicians are a very difficult group to manage, very, very difficult.
And people that have managed other sorts have told me that they’re one of the more difficult, although as I said, I don’t have experience with anybody else. But I will say they are very difficult. The job of the old management style, a physician expected of their manager don’t allow change to occur. And that’s still the mantra to some degree. And in this day and age, that’s impossible, Change not only is occurring, it has to occur. Physicians have got to be on board with what’s coming, and that’s hard.
Lisa Belisle: I can’t really deny anything that you’ve just said. I think I’ve seen this personally as a physician chaffing a little bit under management, although I have a lot of respect for the people that are managing my practice and ultimately, me. I think there’s a different mindset that we have as a result of our training perhaps and there’s a different level of responsibility that’s expected of us. It’s a strange dynamic to be able to go back and on the one hand be responsible in your case for putting children under anesthesia and keeping them alive long enough to get their surgeries and then bringing them back out again and making sure that they’re in good shape. And in my case, trying to work with women who have new breast cancer diagnosis or manage people’s heart disease. And these are people’s lives that you have responsibility for, you’re tasked with being a leader and a protector. And it’s hard to then have somebody come in and say, “Well, we need you to do this, this and this.”
Dr. Dan Landry: Exactly, it is very hard. And I think you and I are of a generation, I think it’s going to have to be a generational change because our training was the captain of the ship model. You are the captain of the ship, you are in charge that a woman that comes to you with heart disease, it is up to you to keep her healthy. And the shift now is in team-based approach. And you and I, we weren’t trained that way. We’re trained to be autonomous. It’s very difficult for doctors trained in our generation to make this shift to a team-based. I don’t mean to say that people aren’t good team players, but team-based approaches you got to follow a protocol. This is a path where you got to follow it even though you may not agree with it. And physicians are very bad at that, they don’t want to be told how to practice.
Lisa Belisle: I’m smiling because I think that’s true although personally I like being part of a team and many of the physicians I work with enjoy being part of a team. I think what I struggle with is at the end of the day, it’s my medical license that ends up being at risk. The malpractice suits are largely filed against physicians. Even though we are part of a team, if something goes wrong on the team, we still are taking responsibility for that. Do you see that shifting so that it enables us to feel more comfortable with the team-based approach?
Dr. Dan Landry: No. It gets into the realm of legislation, that’s a legislative effect. I believe where health care is going is into a much more, we call it a cookbook approach, it’s much more predicated on best evidence. You see the Watson project for the IBM that Watson is now reading x-ray studies, pathology studies, recommending cancer treatments. And I think the cancer treatment is a good example of no matter how good a physician or a team of physicians is, they cannot keep up with the literature that occurs in cancer medicine, it’s just physically impossible. You need decision support. And physicians are less and less developing, making, and implementing the final decision as opposed to using a lot of these decision support tools. And I think that’s what I mean with myself, for instance, uncomfortable with not having it in my head but relying on other things to tell me what the best thing to do is.
I’m just not comfortable with that. And I think we have to be and I think the younger generation is a little more comfortable than I am in that regard.
Lisa Belisle: Yes. What about the recent news of the heads of these organizations coming together and deciding outside of medicine that they want to do something about medicine?
Dr. Dan Landry: I can’t tell you how glad you are you asked me that. Oh, [inaudible 00:50:15] get to that. We’ve relied on the government to help with health care. President Obama did the ACA, which no matter how you feel about the politics was a movement in the right direction in that he was putting a focus on health care. There is a problem, let’s try and fix it. As what happens in politics, it became partisan and some people thought it was the worst thing and some people thought it was the best, but it started the conversation. But what did not occur in the ACA and certainly is not occurring in the debate today is the cost of health care. What they’re talking about is who’s actually going to pay for health care, they’re not talking about the fundamental problem, which is the cost, which we pay almost 18% of our GDP to health care whereas the next most expensive health care in the country is 10 or 11%, international averages around 9.
For every individual in the US, we’re spending $10,000 a year on health care. These companies, you’re referring to Amazon, J.P.. Morgan and Berkshire Hathaway have come together to develop innovative ways for the delivery of health care. Why are they doing that? It gets right back to why health insurance was developed in the first place, which was to keep the workforce healthy and insure a workforce for companies and country. That is why health care and insurance came about. These folks that employ millions of people can no longer afford health care for their employees, it’s just too expensive. It’s become the single largest expenditure for their companies, they are coming up with new solutions. And I believe that health care reform will not occur through the government or through legislation, it’s going to occur through avenues such as that.
Insurance companies really don’t have an impetus to change health care, they’re simply a conduit for the money. In Maine here, we have a large number of self-insured companies. Self-insured meaning like BIW, they don’t have insurance per se, they pay for it out of their pocket. And that’s starting to trickle down to medium and small-sized companies that are taking on this risk so that they can control their costs even more. It’s going to be innovations like self insurance, these big companies that innovate that is going to be where the reform is going to come from. I am convinced of that. And what’s it going to look like? I don’t know although there is technology out there. You can get an EKG done from your smartphone at home with a cardiologist reading in 30 minutes. You can do most things online.
There is an enormous amount that can be done. And hospitals and health systems are reliant upon the money coming in to them because they have such high fixed overhead that this disruptive innovation will have profound consequences for the hospital systems and the hospitals particularly in a rural state like Maine. We no longer can support 39 hospitals. Health care reform is going to come from people like Jeff Bezos and Warren Buffett and those folks. They have the money to invest in it. That’s where it’s coming from.
Lisa Belisle: Well, you raise an interesting point because I enjoy taking care of the patients from Bath Iron Works, for example, because they will come in, and I think also L.L.Bean. There’s a few other major employers within the state. And the patients will come in and they will have been seen by their health coach, they’ll have their numbers in front of them. I have a set of labs that have been done by these patients. I’m already starting with more information than I would otherwise. And that’s really useful to me as a primary care doctor. However, the point that you’re raising about it no longer being money that goes into the medical system is a good one. If I am not ordering the labs and they’re not being drawn by my hospital and not being run by my hospital, there’s already a loss of profit. It’ll be interesting to see how this all works out because you can’t really pull a string in one part of the world they say and not feel a tug at the other.
Dr. Dan Landry: And these companies before they relied on the insurer and they thought the insurer was looking out for the best interest of finding the lowest cost. They were or they weren’t, it’s immaterial at this point. But now, their labs are a great example. They can send lab specimens essentially all over the country so you find the lowest cost. And now consumers are starting to do that as well because as I mentioned earlier when I got hurt, we are spending an enormous amount of out-of-pocket expenses. People are starting to look for lower cost, lower cost lab work, lower cost radiology services. And you go to the doctor and the doctor may prescribe three tests and four medicines and people are saying why. There’s much more consumerism in medicine. It tends to be more outside of Maine because there’s more choices outside of Maine than there is in Maine, but it’s coming.
Lisa Belisle: Well, I will be interested to see as my son finishes medical school in a few years, to see where things go with him.
Dr. Dan Landry: Good for him.
Lisa Belisle: I know my dad, he’s 70 something years old, he’s still practicing medicine. The landscape of medicine has just completely changed since he was starting. I know that you have two kids Sam and Chris who are 23 and 20, to know what the things are going to look like for our kids will be fascinating I believe.
Dr. Dan Landry: It will be. I wish the best for your son practicing medicine, we absolutely need more physicians. I’m more concerned about our kids in their ability to pay for health care. If we continue on this trajectory, they won’t be able to afford health care, they just won’t. And if they can’t afford health care, it’s going to be to the detriment of every other program. That’s my biggest concern. And if we don’t change the trajectory, our kids and their families are going to really struggle with health in the future, their own health.
Lisa Belisle: Doing the work that you’re doing in health care reform, I wish you all the best with this. I’ve been speaking with Dr. Dan Landry who is a pediatric anesthesiologist who is now working on his clinical practice and being an advocate for health care reform within Maine and throughout the United States. Thank you so much for coming in today.
Dr. Dan Landry: Thank you for having me.
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Lisa Belisle: You’ve been listening to Love Maine Radio show number 348. Our guests have included Emily Sharood and Johnny Dickinson, and Dr. Dan Landry. For more information on our guests and extended interviews, visit lovemaineradio.com. Love Maine radio is downloadable for free on iTunes. For a preview of each week’s show, sign up for our e-newsletter and like our Love Maine Radio Facebook page. Follow me on twitter, it’s Dr. Lisa. And see our Love Maine Radio photos on Instagram. Please let us know what you think of Love Maine Radio. We welcome your suggestions for future shows. Also, let our sponsors know that you have heard about them here. We’re happy that they enable us to bring Love Maine Radio to you each week. This is Dr. Lisa Belisle, thank you for sharing this part of your day with me. May you have a bountiful life.
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